Provider Demographics
NPI:1487969150
Name:HITCHCOCK, ROBERT DEREK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEREK
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N KINGS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2326
Mailing Address - Country:US
Mailing Address - Phone:843-712-1703
Mailing Address - Fax:
Practice Address - Street 1:5900 N KINGS HWY STE C
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2326
Practice Address - Country:US
Practice Address - Phone:843-712-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist